4 Signs Your Current Health Plan Strategy Isn’t Working (And What Employers Can Do About It)

Healthcare Costs Keep Rising

Most employers expect healthcare costs to increase over time. However, if your annual renewals continue to bring unexpected cost increases and you don’t have visibility into what’s driving them, that’s a red flag.

Without access to claims data, utilization patterns, and cost information, it’s difficult to know whether your benefits strategy is delivering results, or where opportunities exist to improve outcomes and control spending.

Questions to consider:

• Do you know which services are driving the majority of your healthcare spending?
• Can you identify high-cost conditions within your employee population?
• Are you able to compare costs across providers?
• Do you regularly review your claims data and trends?
• Can you measure the impact of benefit plan changes?
• Are your benefit investments aligned with employee needs?
• Do you know which programs are delivering value?
• Are there noticeable shifts in behavior in response to benefit plan changes?

If the answer to any of these questions is no, your organization may be missing opportunities to reduce unnecessary spending and improve employee health outcomes.

Employees Aren’t Using High-Value Healthcare Options

Offering benefits is only part of the equation. Employees also need to understand how to use them effectively.

Many organizations invest in provider networks, preventive care benefits, and wellness resources, only to discover that employees continue seeking care in higher-cost settings or are unaware of lower-cost alternatives.

For example, an employee may schedule an MRI at a facility charging thousands of dollars more than another provider offering the same service with comparable quality outcomes.

When employees lack information about cost and quality, healthcare decisions often default to convenience or familiarity.

Signs this may be happening include:

• Low utilization of Preferred-Value Providers
• Limited engagement with cost-estimator tools
• Frequent use of high-cost facilities for routine services
• Employee confusion about benefits

An effective health plan strategy includes ongoing communication and education. When employees understand where to find high-value healthcare, they are better positioned to make informed healthcare decisions that benefit both themselves and the organization.

Preventive Care Utilization Is Low

Preventive care is one of the most effective ways to improve health outcomes and reduce long-term healthcare costs.

Services such as annual wellness visits, preventive screenings, and vaccinations can help identify health concerns before they become more serious, and more expensive, to treat.

If employees are not taking advantage of preventive care services, your health plan strategy may be more focused on treating illness rather than preventing it.

Common indicators include:

• Low rates of annual physicals
• Missed preventive screenings
• Increasing rates of chronic conditions
• Above benchmark urgent and emergency care utilization

Employers can encourage preventive care use through benefit design, targeted communications, incentives, and partnerships with providers that prioritize proactive care.

The goal is to create an environment where employees are empowered to take charge of their health before issues become major medical events.

Employees Are Frustrated with Their Healthcare Experience

A health plan can look good on paper while still creating friction for employees.

If employees struggle to find providers, understand their benefits, estimate costs, or navigate the healthcare system, they may delay care or make decisions that lead to higher costs and poorer health outcomes.

Common signs include:

• Complaints about healthcare costs
• Difficulty finding in-network providers
• Frequent questions about benefits
• Low satisfaction with healthcare resources
• Delayed or avoided care
• Above-average utilization of urgent and emergency care

Organizations that prioritize employee education and the overall benefits experience often see greater engagement, increased use of preventive care, and higher satisfaction with their health plan.

However, even when lower-cost, high-value care options are available, many employees aren’t confident navigating the healthcare system or understanding the choices available to them. Employees may default to familiar providers or care settings because they don’t know where else to go.

By providing easy-to-use tools, educational resources, and access to trusted provider networks, employers can simplify the healthcare experience. When employees know where to start and feel empowered to make informed decisions, they’re more likely to choose high-value care that benefits both their health and the organization’s healthcare costs.